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Storm Clouds Parting

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Wrapped in three blankets, beads of sweat on her forehead, she shivered, sat up, laid down, and rolled over in a futile attempt to find comfort. An emesis bag in her shaking hand, she looked up from her sunken eyes and said in a soft voice, “I can’t go on living like this…. I need to do this for my kids.” A year ago this young woman had an operation and was prescribed oxycodone; her postoperative recovery was complicated which resulted in more pain medications. Then she had dental work done- more pain pills. Meanwhile, the oxycodone helped numb difficult feelings from stressful life events. She soon found if she did not take them, she felt terrible. When doctors became reluctant to prescribe the medications, she bought them on the street. The pills were expensive- heroin was cheaper. She never intended to become addicted; she never thought it could happen to her, but it did.

My patient is not alone: America is in the midst of an opioid epidemic. Addiction to prescription opioid drugs (oxycodone and hydrocodone, for example) and heroin is at a record high and continues to increase. There are currently 2 million Americans addicted to pain medications and 500,000 addicted to heroin. Every day 90 to 100 people in our country die from overdose. The number of people addicted to opioids each year continues to rise, and there does not seem to be an end to the epidemic in sight. It is as if there is a dark storm cloud over the country, a cloud we all wish would just go away so we can see the sun again.

To add to this gloomy predicament, the majority of those addicted to opioids are young, typically in their 20s and 30s, and there is often no cure for this disease. Addiction to opioids is a chronic disease, characterized by remissions and relapses over a lifespan.

Just as there is no simple cure for opioid addiction, there is no one solution to reverse the current epidemic. Solutions to our opioid epidemic will take time, persistence, and a variety of interventions over many years. We need the help of the companies who make the medications, healthcare providers who prescribe them, and you, a potential recipient of pain medications. Here are a few ways in which we can all work towards ending this epidemic:

1. Pharmaceutical companies should stop heavily marketing the symptom of “pain” and their prescription pain pills. Historically the pharmaceutical industry has successfully popularized medical problems through advertising when there is a drug to sell, be it for insomnia, erectile dysfunction, or low testosterone, for example. The stakes are too high to push treatment of pain with opioids.
2. Doctors, physician assistants, and nurse practitioners have to reduce the number of prescriptions they write for opioid medications. Since 2010, the number of opioid medication prescriptions written in America has steadily declined, which is terrific news. Despite this trend however, healthcare providers in America currently prescribe four times as many opioid medications as doctors in Europe. Having more pain pills in circulation enables more people to become addicted to them.
3. Patients who receive prescription opioid medications need to be more careful with these powerful medications. Research has shown that 57% of people who become addicted to opioids begin their path of addiction after having first received opioid medications from family or friends. If you are prescribed pain pills by your doctor, do not share them with others. In addition, store unused medications where they cannot be stolen, or better yet, dispose of them.
4. Communities need to de-stigmatize opioid addiction. Addiction is a disease, not a moral failing. Like the young woman I have described, people who become addicted are our neighbors and our friends’ children. It is important to acknowledge that anyone can become troubled by opioid addiction and that everyone needs our support.
5. If you or someone you know becomes addicted to opioid medications or heroin, there is help in the form of “medication assisted treatment.” Buprenorphine, or “suboxone,” is a medication that doctors can prescribe in an outpatient clinic setting that enables a person to live a normal, addiction free life. These medications help but can be expensive; tell your representatives in government to support policies that fund opioid addiction treatment. In addition, to be allowed by the FDA to prescribe Suboxone, physicians must complete an eight hour trianing course that can be done at a live conference or online. Encourage your healthcare provider to pursue training in order to prescribe this life changing medication.

Ending America’s opioid epidemic will take time and action in a variety of ways. Reversing the epidemic will require efforts from pharmaceutical companies, our government, healthcare professionals, as well as individuals such as you. It will truly take a concerted effort. We are all in this together.

My patient received her first dose of Suboxone that day. An hour later she was no longer shivering, perspiring or vomiting. She looked exhausted, but relaxed. “You look a lot better, I commented.” She looked up at me and wearily replied, “At least I don’t feel like I’m dying anymore.”

The following day she returned to the clinic for follow up. I entered the room to see a happy and extremely grateful young woman; she smiled and said, “I feel normal now.” Her skin had a rosy color and was bright with light. While my patient will need continued treatment with Suboxone for many years, or even her entire life, the dark cloud of addiction had departed in the exam room that afternoon. The sun was shining bright.